Früh vs. spät: Gibt es den optimalen Zeitpunkt für einen chirurgischen Eingriff am Bandscheibenvorfall der lumbalen Wirbelsäule? Ergebnisse einer prospektiven matched pair-Kohortenstudie

J. M. Salehin; F. Krummenauer; K. Schaper; F. W. Weber

doi:10.1055/s-0034-1385888

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, Inhaltsverzeichnis

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2015; 25(01): 19-30
DOI: 10.1055/s-0034-1385888

Wissenschaft und Forschung

Früh vs. spät: Gibt es den optimalen Zeitpunkt für einen chirurgischen Eingriff am Bandscheibenvorfall der lumbalen Wirbelsäule? Ergebnisse einer prospektiven matched pair-Kohortenstudie

Early vs. Late: Can We Define Optimal Timing for Lumbar Disc Surgery? Results of a Prospective Matched Pair Cohort Trial on the Comparison of Primary and Secondary Health Care

J. M. Salehin

¹Institut für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke, Witten

,

F. Krummenauer

¹Institut für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke, Witten

,

K. Schaper

¹Institut für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke, Witten

,

F. W. Weber

²Neurochirurgische Klinik, Kliniken der Stadt Koeln gGmbH, Koeln

› Institutsangaben

Abstract

Zusammenfassung

Fragestellung: Ziel der monozentrischen prospektiven matched pair-Kohortenstudie war die Identifikation eines möglichen Unterschieds im inhaltlichen Outcome nach Operation am lumbalen Bandscheibenvorfall in Abhängigkeit des Zeitpunktes der chirurgischen Intervention.

Material und Methoden: Betrachtet wurden 2 × 78 im Verhältnis 1:1 post-hoc gematchte Patienten mit lumbalem Bandscheibenvorfall. Die Kohortierung erfolgte anhand der konservativen Vorbehandlungsdauer (Kohorte 1: maximal 12 Wochen und Kohorte 2: 12–36 Wochen). Der primäre klinische Endpunkt wurde entlang des ODI definiert als dessen 6-monatige Änderung post-prä OP; zwischen den beiden Patienten eines matched pairs wurde die intra-pair-Abweichung als Effektmaß bestimmt.

Ergebnisse: Es ließ sich bei medianen 6-monatigen ODI-Anstiegen von 36% vs. 32% kein statistisch signifikanter Unterschied zwischen den Kohorten im primären Endpunkt zeigen (p=0,649).

Schlussfolgerung: Der frühere Zeitpunkt der operativen Intervention führte nicht zu einem signifikant überlegenen Therapieergebnis.

Abstract

Purpose: To determine whether the clinical outcome of primary spinal surgery for lumbar disc herniation is better than the result of secondary surgical intervention after conservative treatment.

Materials and Methods: The study included 2×78 patients matched post hoc in a ratio of 1:1. The patients were divided according to the duration of their prior treatment (cohort 1: max. 12 weeks and cohort 2: 12–36 weeks). We examined the level of disability one day before and 6 months after surgery with percentage change in ODI, defined as primary endpoint and its intra-pair difference specified as effect measure.

Results: In the course of 6 months the increase in ODI was 36% for cohort 1 and 32% for cohort 2. No significant difference was found in the effect measure of the primary endpoint (p=0.649).

Discussion: The findings indicate that the result of early surgical intervention in lumbar disc herniation is not significantly superior to the outcome of late surgery after failed conservative therapy.

Schlüsselwörter

Bandscheibenvorfall - Rückenschmerz - spinale Chirurgie - Zeitpunkt

Key words

lumbar disc herniation - spine surgery - low back pain - timing

Volltext

Referenzen

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